Amenorrhoea Flashcards
What are the two types of amenorrheoa
primary and secondary
secindary is more common
What are the 2 definitions of a menorrhoea?
Failure of menorrhoea to start before the age of 16 yo
The failure or acquisition of secondary sexual characteristics by the age of 14
What is the definition of secondary amenorrhoea?
Cessation of menses for greater than 6 months in a pre-menopausal woman
What are the primary cases of amenorrhoea? 4
Mullerian agenesis - no uterus develops
Outflow tract obstruction - imperforate hymen / transverse vaginal septum. Blockage of menses
Constsitutional Delay of puberty (no secondary sex characteristics)- Kallmann Syndrome
Gonadal Dysgenesis - Turners syndrome
What is Kallmann Syndrome?
A genetic condition which causes the failure to start or complete puberty. It is caused by the non-migration of the neurones responsible for releasing GnRH. Patients have no sense of smell
What are the most common causes of Secondary Menorrhoea?
Pregnancy Hypothalamic amenorrhoea Hyperprolactinoma Premature Ovarian Failure Hypothyroidism Outflow tract obstruction
What are the hormonal subtypes in amenorrhoea?
Hypogonadotropic Hypogonadism - no GnRH from hypothalamus
Hypergonadotropic Hypogonadism - Normal GnRH, FSH + LH but problem with ovaries
Normogonadotropic - Everything seems to work but no menses
Hyperprolactinaemic - Inc prolactin from ant pituitary, no dopamine
How should you take a history from a woman who presents with amenorrhoea?
Age - 16 primary, 45 secondary
Age of Menarche - early periods and 45 may mean menopause
Ever normal menses? no could be PCOS
Duration of symptoms - >6 months is important
Sexual / contraception - pregnant? normal not to have periods?
What diseases should you consider if FSH, LH and TFTs are normal (normogonadotropic)
Cushings, acromegaly
PCOS - weight gain, hirsutism
Asherman’s syndrome
What is Asherman’s Syndrome?
Fibrosis and adhesions of the endometrium usually caused by iatrogenic trauma or sever infection
What drugs are associated with an increase in prolactin? hyperprolactinaemic amenorrhoea
Antipsychotics
Anti-dopaminergics (parkinsons)
Histamine Blockers
What are the causes of hypogonadotropic hypogonadism?
Eating disorders
IBD
Liver disease
Renal disease
What would you see on examination of a patient with turners syndrome?
Short stature
webbed neck
low set ears
low hairline
What investigations would you do on a patient with amenorrhoea?
B-HCG
Gonadotrophins and oestradiol
If a woman had hypogonadotropic hypogonadism, what would her hormone profile look like?
Low FSH/LH
Low Oestradiol
